Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution

Kaliszewski, Krzysztof; Diakowska, Dorota; Wojtczak, Beata; Rudnicki, Jerzy

doi:10.1371/journal.pone.0236257

Cited by 14 publications

(18 citation statements)

References 40 publications

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“…Paradoxically, to make this issue more interesting, or even complex, some other authors recommend that people with excess body weight be encouraged to join cancer screening programs [ 9 ]. We presented our opinion concerning “cancer screening activity” in a previous study; however, we did not analyze PTC screening according to BMI [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Obesity and Overweight Are Associated with Minimal Extrathyroidal Extension, Multifocality and Bilaterality of Papillary Thyroid Cancer

Kaliszewski

Diakowska

Rzeszutko

et al. 2021

JCM

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Epidemiological studies have shown a strong association between high body mass index (BMI) and papillary thyroid cancer (PTC). We assessed the clinical and histopathological features of PTC in patients with a higher BMI and compared them to analogous parameters in PTC patients with a normal BMI. We retrospectively analyzed 5021 medical records of patients admitted and surgically treated for thyroid tumors in one center between 2008 and 2018. Finally, we extracted data from 523 adult patients with PTC and stratified patients into two groups according to BMI: Group 1 with BMI < 25 kg/m2 and Group 2 with BMI ≥ 25 kg/m2. Data stratification was performed to estimate the association of overweight and obesity with clinical and histopathological features of PTC in both univariable and multivariable binary logistic regression analyses. Overall, compared to patients with a normal BMI, overweight and obese patients had a greater risk of minimal extrathyroidal extension (minimal ETE), multifocality and bilaterality of PTC (p < 0.001 for all). Analysis did not show that BMI was significantly associated with the more advanced tumor-node-metastasis (TNM) stage (p = 0.894). Obesity and overweight were significantly associated with higher aggressiveness of PTC. When considering various management options for PTC patients, these findings regarding overweight and obesity should be taken into consideration during the decision-making process.

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Section: Introductionmentioning

confidence: 99%

Obesity and Overweight Are Associated with Minimal Extrathyroidal Extension, Multifocality and Bilaterality of Papillary Thyroid Cancer

Kaliszewski

Diakowska

Rzeszutko

et al. 2021

JCM

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“…In our earlier study, we described this phenomenon as “cancer screening activity”. 1 Cibas et al 2 estimated that TNs might be observed in 50% of patients aged 50 years, with a low overall malignancy risk of 5 to 7%.…”

Section: Introductionmentioning

confidence: 99%

“…The most commonly employed preoperative diagnostic tool for TN evaluation remains the ultrasound-guided fine needle aspiration biopsy (UG-FNAB) procedure. 1 , 2 On the basis of this screening test, The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) was introduced in 2009 2 and subsequently modified in 2017. 3 , 4 It consists of six categories that enhance and standardize TN management.…”

Section: Introductionmentioning

confidence: 99%

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

Kaliszewski

Diakowska

Rzeszutko

et al. 2021

CMAR

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Purpose Although some prognostic variables and risk factors for thyroid cancer (TC) are age-related, the association between age and the risk of TC in patients with thyroid nodules (TNs) assigned to atypia of undetermined significance (AUS) and follicular lesion of undetermined significance (FLUS) is poorly estimated. The aim of this study was to assess the histopathology of AUS/FLUS and the risk of TC according to the age of the patients at the time of AUS/FLUS diagnosis. Patients and Methods Among 5021 individuals treated for TNs at one institution from 2008 to 2018, 161 (3.2%) patients with 161 TNs assigned to the AUS/FLUS category (1 nodule per patient) were selected and stratified by age at initial diagnosis: <55 years, 55–75 years and >75 years. Logistic regression analysis was used to estimate the association of age with the risk of TC diagnosis. Results Ninety-one (56.52%) patients <55 years old, 58 (36.02%) patients 55–75 years old, and 12 (7.45%) individuals >75 years old were identified. There were 130 (80.7%) females and 31 (19.3%) males with a mean age of 50.6 ± 16.12 years. Among the evaluated TNs, 142 (88.2%) were ultimately diagnosed as benign, and 19 (11.8%) were diagnosed as malignant. Younger age in patients was significantly related to malignancy outcome (p=0.024 for age <55 years). Patients aged 55–75 years had a significantly lower risk of TC than the other age categories (p=0.040). The risks of high vascularity and fast tumor growth were significantly higher in the youngest category than in the other categories (age <55 years old: p=0.045 and p=0.002, respectively). Conclusion Although patients with TNs classified as AUS/FLUS by ultrasound-guided fine needle aspiration biopsy (UG-FNAB) are not typically qualified for surgery, it is worth noting that younger patients with an AUS/FLUS diagnosis might be at a higher risk of TC.

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“…Despite the progressive increase in incidence, the disease-specific mortality in the US has increased marginally from 0.40 to 0.46 per 100,000 and can be accounted for by the advanced and dedifferentiated cancers that occur most commonly in an ageing population [9]. In 2020, 43,646 patients died from thyroid cancer (27,740 women and 15,906 men) (Global Cancer Observatory, IARC), almost no change from the 40,000 estimated global deaths in 2012 [6]. These trends of incidence and mortality are seen across the developed world, with pockets of extreme increase in incidence in countries where thyroid screening has been adopted, such as in South Korea [5,10,11].…”

Section: Epidemiology Of Dtcmentioning

confidence: 99%

“…In some European countries and the US, 45 to 70% of thyroid malignancies are considered "over diagnosed", based on studies comparing the expected and observed prevalence of thyroid cancer [26]. This conclusion is also inferred by the rise of early-stage thyroid cancer and the incongruity of there being more cancer with no change in mortality over decades [27]. The alternative explanation, that early diagnosis coupled with excellent treatment has compensated for a real thyroid cancer epidemic, appears less substantiated.…”

Section: Overdiagnosis and Overtreatmentmentioning

confidence: 99%

Differentiated Thyroid Cancer: A Health Economic Review

Heede

Tolley

Marco

et al. 2021

Cancers

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The incidence of differentiated thyroid cancer (DTC) is rising, mainly because of an increased detection of asymptomatic thyroid nodularity revealed by the liberal use of thyroid ultrasound. This review aims to reflect on the health economic considerations associated with the increasing diagnosis and treatment of DTC. Overdiagnosis and the resulting overtreatment have led to more surgical procedures, increasing health care and patients’ costs, and a large pool of community-dwelling thyroid cancer follow-up patients. Additionally, the cost of thyroid surgery seems to increase year on year even when inflation is taken into account. The increased healthcare costs and spending have placed significant pressure to identify potential factors associated with these increased costs. Some truly ground-breaking work in health economics has been undertaken, but more cost-effectiveness studies and micro-cost analyses are required to evaluate expenses and guide future solutions.

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Cancer screening activity results in overdiagnosis and overtreatment of papillary thyroid cancer: A 10-year experience at a single institution

Cited by 14 publications

References 40 publications

Obesity and Overweight Are Associated with Minimal Extrathyroidal Extension, Multifocality and Bilaterality of Papillary Thyroid Cancer

Obesity and Overweight Are Associated with Minimal Extrathyroidal Extension, Multifocality and Bilaterality of Papillary Thyroid Cancer

The Correlation of Age with Prognosis of Atypia of Undetermined Significance and Follicular Lesion of Undetermined Significance in Thyroid Nodules

Differentiated Thyroid Cancer: A Health Economic Review

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